7 Tips for Physician Representation in Hospital Governance

Of physicians who do not trust hospitals, 56 percent of them attribute their mistrust to a lack of physician leadership or representation on hospital boards, according to a 2010 PricewaterhouseCoopers report. Physician representation on governing bodies can help hospitals meet the challenges of healthcare reform, improve hospital-physician relationships and increase employee engagement. Here are seven tips for improving physician representation in hospital governance.

1. Healthcare reform already provides incentives for physician involvement. Healthcare reform aims to foster a closer partnership for hospitals and physicians, increasing collaboration and accountability. While many leaders may strive to offer incentives for physician involvement in hospital governance, the incentive may simply be healthcare reform itself. "Smart physicians know they have to be partnered with a great hospital to be successful after reform," says Connie Curran, EdD, RN, CEO of Best on Board. "Same thing is true for hospitals — if they don't have great physicians, they can't win either." A strengthened need for one another may leave governance roles more attractive to physicians and other medical professionals.

2. Clearly communicate the reasons for increasing physician involvement in governance. Governing boards and CEOs should communicate with physician leaders and reach agreement on approaches to increase physician participation in governance roles. Attempts to change the traditional number of physicians on boards or committees may be greeted with suspicion. Furthermore, a hospital's vision for physician governance should correspond to its 5-10 year vision for physician-hospital alignment and integration. For instance, if a hospital's vision is to be financially and clinically accountable for the quality of care it provides, it needs a close relationship with medical staff — and more physician representation on committees or boards. 3. Use committees to help physicians voice decisions and become involved. Hospital boards may form committees specifically for physicians, such as clinical advisory counsels or physician-relations groups. Ms. Curran serves on the board for Silver Cross Hospital in Joliet, Ill., and says the hospital recently formed a Guiding Coalition to identify physician concerns and communicate them to the board. "The Guiding Coalition has two board members, four hospital executives and 12 physicians," says Ms. Curran. With extensive clinical expertise, the committee evaluates IT systems, ACOs and shared savings contracts, among other components of healthcare reform, and then reports back to the board of representatives. "This committee has been meeting once a month if not more," says Ms. Curran. "It's a really active, serious committee that is working hard in a partnership."

4. Combine C-suite executives and physician executives to oversee quality. Hospitals may want to create a senior-level hospital operations council to oversee quality and clinical operations that reports to the board. Half of this type of council should be senior executives and the other half physician executives, such as the hospital CMO, chiefs of medicine and surgery and the chief of the hospital's medical group, according to Great Boards, a newsletter from the governance consulting firm Bader & Associates.

5. Physicians need not be hospital-employed to serve on the board. Many hospital-employed physicians serve on boards, but non-profits must be careful to ensure more than half of the board is independent, as required by the Internal Revenue Service. An independent director, by definition, is not compensated as an employee, not compensated more than $10,000 as an independent contractor and has no business transactions with the hospital. Therefore, if a hospital board has reached the maximum number of employed physicians permitted by the IRS, it can still resort to independent physicians for governance roles. These individuals may be independent physicians on the hospital's medical staff, or they may work as physicians for non-competing hospitals, schools, professional societies or universities. This allows the non-profit hospital to maintain an independent majority while still representing physicians and gaining clinical expertise.

6. Consider representation from other medical professionals. While nurses make up the largest group of employees in hospitals, only 2 percent of hospital board members are nurses, according to Ms. Curran. "You would want nurses on boards because they really know how the hospital runs — 24 hours a day, seven days a week," says Ms. Curran. Other clinical experts to consider for leadership positions in governing bodies include public health officials, corporate medical directors, quality and hospital management experts.

7. Physicians should be prepared to offer more than clinical expertise. When selecting physician directors, boards may want to consider the physician's availability, potential conflicts of interest, commitment to the mission, strategic thinking and understanding of healthcare reform and hospital management. "It's important that the board not only have good representation, but that the board is educated," says Ms. Curran. "A lot of the rules have changed with reform and the board has to understand what these rules are to help organizations succeed."